Don’t play the numbers


When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair.  When I asked why, Allan told me he could not walk.  I was concerned, but when I examined him, I found his vital signs were fine, he had no vertigo, and, most importantly, his legs were very strong (5 out of 5, as we say).  I inquired further.  What made Allan think he could not get up?  Oh, he told me, his blood count test had come back and he was too anemic to move.

Allan noted that his hemoglobin, which was usually nine (moderately anemic), had fallen to eight (moderately to severely anemic).  He concluded that he should not walk and, more importantly, he must move as little as possible.  Allan planned to stay in bed until the blood count recovered.


“But, Allan, how do you feel?  Are you weak?  Are you dizzy?  Are you short of breath? Do you have pain?”

“Oh no, doc.  I feel fine.  And I plan to keep it that way.”


Now, do not get me wrong; I am an oncologist and therefore love numbers.  The results of blood tests, X-rays, biopsies, pathology reports, physical exams and bone marrows can be digitized. We compulsively tabulate milligrams of chemotherapy, IVs by the milliliter and radiation centigray.  Cancers are weighed by circumference and mass, as we calculate the probability of response with statistical measures which make the head spin. We measure life itself in terms of prognosis and survival granted in days, weeks, and months.  What oncologist does not daily talk with patients about that magical five remission years?

The problem with all these numbers, is they are just that; numbers.  Specters on a computer screen or ink on paper.  Very often, they do not correlate with an individual patient’s body, or a specific moment in time and numbers may have little to do with long-term results.  They are probabilities for thousands of people, while the patient is just one. Measurements may not reflect new healing, a complex condition or may be simply wrong, delayed and confusing.  In the end, all numbers fail to answer that one vital question; How do you feel?

My point here is that many patients and families fixate on measurements and digits and lose sight of that one key result, the well being of the patient.  Instead of saying, “Hey, I’m just a little stronger, today,” we say “Well, I’m not going to enjoy this day, until I find out about the liver count.” Our tunnel vision tracks tumor markers, blood pressure, PET Scans or a thousand other printouts. We use numeric strings to connect our health and therefore our lives and all those pluses and minuses distract us, as it did with Allan, from fighting against the disease and living well each special, irreplaceable day.

Now, of course I do not mean completely ignoring critical results and I realize the importance of understanding what is happening to your health. If your doctor tells you that you have a 99% constriction of a coronary artery, it is a bad time to train for a marathon.  If the INR test shows too much blood thinner, delay that javelin catching tournament.  Moreover, if results indicate a need to change your cancer treatment, then it is time to go to war with that stupid disease and rejoin the attack.

However, try not to fixate on every dram, gram and quanta.  Leave that draining behavior to your physician; let them get the ulcer.  Every cancer doc lives for the mathematical precision and calculation of the human biological experience.  They are nerds in a white coat.  Healing entails more important work than fixating on numerical detail.

You have to get out, eat, exercise, gossip, teach, laugh, make love, curse, fight and survive, and, frankly, obsessive measurement will drag you down. If you are going to play-the-numbers, then do it where gambling is fun, like Atlantic City.  There if you roll the dice, the worse thing that can happen is empty pockets and you will not stay up nights worrying about the next roll.



  • Can only agree. While I follow my counts etc, the subjective is as important. During chemo, I also developed my own 'crumminess' scale to capture how bad the side effects were.
    • James Salwitz, MD
      Do you wish to share your "crumminess" scale? jcs
  • Jim.... I love the wise and good man that I have watched grow up. Your father sends some of your writings on to me and if no big trouble, would love to be on your list. When i hit 90, in April, it seemed like a good time to take stock and i have had a very rich time doing so. Last Friday, Patricia mentioned that ALL her daughters as well as she have their Masters. Since then I have had a lovely E-mail advisory from Empire State University; the College without walls ahd where I obtained my BS when I was 57. And I found out that to receive a Masters, Statistics and Micro Economics were required.. which I do not have.. anyway the responsive person at E.S. suggested an alternative and I will be doing an on-line only program in the fall on Community Issues, focussing on the elderly. Forgive me for this long prattle..But thanks for what you do. You did inspire me. The best to the family and best wishes. Aunt Pat
    • James Salwitz, MD
      How extraordinary and cool. To quote a patient of hours; "If I had known that I was going to be 101, than I would have finished College when I was 70." If you require tuition reimbursement, let me know. jcs
  • Amy Miller
    Very very very well written***...I love data numbers too but I feed into them also. Below is the way to go!!! You are a wise man! ***You have to get out, eat, exercise, gossip, teach, laugh, make love, curse, fight and survive, and, frankly, obsessive measurement will drag you down.
    • James Salwitz, MD
      Thanks very much, I am flattered, although "wise" may be pushing it. jcs

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